Gut health and autoimmune disease. Elimination Diet.
I came across this great and long 🙂 article about gut health in relation to autoimmune disease. Below are few excerpts.
From February 2013 Issue of Today’s Dietitian
Gut Health and Autoimmune Disease — Research Suggests Digestive Abnormalities May Be the Underlying Cause. By Aglaée Jacob, MS, RD
“The prevalence of autoimmune disorders is rapidly rising and now affects an estimated 23.5 million Americans, 75% of them women. (source: Autoimmune statistics. American Autoimmune-Related Disease Association website http://www.aarda.org/autoimmune_statistics.php. Accessed November 10, 2012.) Autoimmune diseases are now among the top 10 leading causes of death in American women under the age of 65 .”
Alessio Fasano, MD, a world-renowned pediatric gastroenterologist, research scientist, and founder of the University of Maryland Center for Celiac Research, believes all autoimmune conditions have three factors in common: a genetic susceptibility, antigen exposure, and increased intestinal permeability. (source: Fasano A. Leaky gut and autoimmune diseases. Clinic Rev Allerg Immunol. 2012;42(1):71-78.)
“Besides celiac disease, several other autoimmune diseases, including type 1 diabetes, multiple sclerosis, and rheumatoid arthritis, are characterized by increased intestinal permeability secondary to non-competent tight junctions that allow the passage of antigens from the intestinal flora, challenging the immune system to produce an immune response that can target any organ or tissue in genetically predisposed individuals,” Fasano wrote in the February 2012 issue of Clinical Reviews in Allergy and Immunology.
While it was previously believed that the autoimmune process remained ongoing once activated, this recent evidence indicates that the process could be modulated and possibly reversed by interrupting one of the modifiable factors involved in the autoimmune triad.
Gluten and Zonulin
According to this theory, improving intestinal permeability could better the management of autoimmune conditions. In susceptible individuals, the zonulin system is one of the main pathways that could be responsible for disregulating the tight junctions and perpetuating the autoimmune process by allowing further damage to the target organ and worsening symptoms. Zonulin is normally present in the intestines to control the passage of fluids, macromolecules, and leukocytes, but this protein appears to be overexpressed in patients with autoimmune conditions, resulting in increased intestinal permeability.
Gluten, or any one of its 50 toxic epitopes, is one factor that can modulate zonulin secretion. “Once gluten is removed from the diet, serum zonulin levels decrease, the intestine resumes its baseline barrier function, the autoantibody titers are normalized, the autoimmune process shuts off and, consequently, the intestinal damage heals completely,” Fasano wrote.
Since intestinal permeability is the main factor of the autoimmune triad, which can be modulated, dietitians can play a role in helping treat and manage patients. The abnormal intestinal permeability associated with autoimmune conditions doesn’t necessarily result in digestive symptoms, but it doesn’t hurt to adopt dietary strategies to minimize gut irritants and maximize intestinal health-promoting nutrients to optimize the integrity of the gut lining and possibly slow down the autoimmune reaction.
South Dakota-based dietitian Amy Kubal, MS, RD, LN, with many clients who have autoimmune conditions whose overall health improved by first addressing digestion, uses an elimination diet approach to personalize her clients’ diets. “Certain foods like wheat, gluten, soy, dairy, eggs, nightshade vegetables, nuts, and processed products contain proteins and other components that may, in some individuals, contribute to ‘leaky gut’ and other autoimmune conditions,” Kubal says.
Even without a diagnosis of celiac disease, non-celiac gluten sensitivity should be suspected. With a prevalence six times higher than that of celiac disease, the existence of gluten sensitivity was finally confirmed in a breakthrough study published by the University of Maryland School of Medicine in the March 2011 issue of BMC Medicine. In addition, the high luminal antigliadin antibodies found in SIBO patients put them at increased risk of developing gluten intolerance or celiac disease, according to a study published in August 1997 in the American Journal of Gastroenterology.
Besides the zonulin-stimulating potential of gluten, the large proteins in nuts, eggs, soy, and many grains have a high allergenic potential, while nightshade vegetables (eg, white potatoes, bell peppers, eggplants, tomatoes) contain potentially problematic glycoalkaloids. These foods should all be eliminated for at least four to six weeks to establish a baseline before moving on to the reintroduction phase under a qualified dietitian’s supervision.
During the elimination phase, RDs play an important role in teaching clients how to read food labels; identify hidden gluten, soy, and dairy ingredients; and prepare balanced meals with limited food choices. During the elimination phase, Kubal says that “focusing on real, whole foods that haven’t undergone extensive processing or genetic modification is important for both maintaining and healing the gut” and that “lean or pastured animal proteins, vegetables, some fruit, and healthy fats help to promote intestinal and overall health.”
Typical meals during the elimination diet phase should include nutrient-dense and anti-inflammatory foods with a low allergenic potential, such as chicken salads with leafy greens, avocado and olive oil-based vinaigrette, hearty stews of lean beef with a side dish of cauliflower, or grilled salmon sprinkled with lemon juice and served with a side of vegetables stir-fried in coconut oil.
In the case of an SIBO diagnosis, avoiding high-FODMAP (fermentable oligo-, di-, mono-saccharides and polyols) foods, sugars, and refined carbohydrates also may be a necessary additional step to control digestive symptoms during the elimination phase.
After the elimination diet phase, patients with autoimmune conditions should be experiencing fewer symptoms. It’s not unusual for these clients to report better mood, energy, and digestion. Although an elimination diet can be restrictive, dietitians should emphasize the importance of the slow and systematic reintroduction of food and food groups into their clients’ diets. The challenged foods ideally should be spaced three to seven days apart, using progressively larger servings, whether it be nuts, wheat, gluten, dairy, FODMAPs, eggs, or soy.
RDs should encourage clients to keep a detailed food diary and take notes of their daily symptoms to review at follow-up appointments and determine which foods can safely become part of their diet again. Any changes in their digestion or worsening of symptoms usually associated with autoimmune conditions indicate that the newly challenged food should be eliminated for a longer period of time. Dietitians should reassure clients by explaining that food tolerance may improve over time as the competency of the tight junctions and the integrity of the intestinal lining have recovered.
Dietary Supplements for Gut Healing
In addition to removing potentially offending foods through an elimination diet protocol, dietitians can recommend dietary supplements to promote gut healing and improve autoimmune disease management. “There are some dietary supplements that may further boost gut health: probiotics, fermented cod liver oil, glutamine, digestive enzymes, and medium chain triglycerides can be potent gut healing helpers,” Kubal says.
Vitamin D also appears to play a key role in calming the autoimmune reaction by soothing inflammation and contributing to the integrity of the gut lining, according to a study published in the January 2008 issue of the American Journal of Physiology — Gastrointestinal and Liver Physiology. Since vitamin D food sources are scarce, dietitians should promote the use of vitamin D3 supplements and adjust the recommended dosage according to their clients’ 25-hydroxyvitamin D3 blood levels.
Probiotics also play an important role in alleviating inflammation in the intestines in addition to potentially benefit intestinal permeability by modulating tight junctions. RDs can help clients select the best strains and dosage of probiotics based on their tolerance level.
To your health,